character length restrictions indicated. 1. TITLE OF RESEARCH TRAINING PROPOSAL (Do not exceed 56 characters, Predoctoral Fellowships for Students with Disabilities 2. LEVEL OF FELLOWSHIP Predoctoral 4a. NAME OF APPLICANT (Last, first, middle initial) Lawson, Erika, L 4d. PRESENT MAILING ADDRESS (Street, city, state, zip code) Brown University Box G Rhode Island Hospital c/o: Douglas Hixson Providence RI 02912 4f. OFFICE TELEPHONE NO.(Area 4g. HOME TELEPHONE NO. code, no., and ext.) (Area code and no.) 401-444-2465 401-861-2178 4j. [] U.S. CITIZEN OR U.S. NONCITIZEN NATIONAL or 5. TRAINING UNDER PROPOSED AWARD (See Fields of Training) Discipline No. Subcategory Name 152 Molecular Biology 7a. DATES OF PROPOSED AWARD 7B. PROPOSED AWARD DURATION 60 Form ApprovedThrou,qh06/30/05 OMB No.0925_)002 ...... _-- o_[unreadable]_ ,,_. onlv. Pl: LAWSON, ERIKA L Council: 05/2003 1 F31 CA103372-01 Dual: IRG: IDM Received: 11/20/2002 including spaces and punc_u_,_,,,v 3. PROGRAM ANNOUNCEMENT/REQUEST FOR APPLICATIONS PA-00-068 4b. E-MAIL ADDRESS T 4c. HIGHEST DEGREE(S) / Erika_Lawson@Brown.edu J B.S. 4e. PERMANENT MAILING ADDRESS (Street, city, state, zip code) 3 Ann Lynn Rd Pittsford, NY 14534 4h. PERMANENT PHONE NO. 4i. FAX NUMBER (Area code and no.) (Area code and no.) 401-444-8141 585-248-5093 [] PERMANENT RESIDENT OF U.S. 6. PRIOR AND/OR CURRENT NRSA SUPPORT (Individual or Institutional) [] NO [] YES (If Yes, refer to item 24, Form Page 5) 8. DEGREE SOUGHT DURING PROPOSED AWARD Degree Expected Completion Date PhD. May 2006 9. HUMAN 9a. Research Exempt 9b. Human 9c. NIH-Defined Subjects III Clinical Trial SUBJECTS [] NO [] YES Assurance No. [] NO [] NO If "Yes" Exemption No. [] YES [] YES 1la. NAME OF SPONSOR (Last, first, middle initial) Hixson, Douglas A. Te,ephone 401-444-8859 FAX 401-444-8141 E-ma, Address Douglas_Hixson@Brown.edu 11c. DEPARTMENT, SERVICE, LABORATORY, OR EQUIVALENT Medicine 11d. MAJOR SUBDIVISION Medical Oncology 13. NAME AND TELEPHONE NO. OF ADVISOR IF DIFFERENT FROM 11a. Telephone Name and address of institution where research training will take place if different from Item 11 b. Address S 9 through 14 Phase 10a. VERTEBRATE ANIMALS 10b. Animal Welfare Assurance [] NO No. [] YES A3922-01 1lb. NAME OF PROPOSED SPONSORING INSTITUTION Rhode Island Hospital Address 593 Eddy Street Providence, R.I. 02903 12. ENTITY IDENTIFICATION NO. 1050258954A1 DUNS NO. (if available) 07-571-0996 14. NAME OF OFFICIAL IN BUSINESS OFFICE Peggy McGill Telephone 401-444-5113 FAX 401-444-4061 T_t,e Director, Research Admin. Address Rhode Island Hospital 593 Eddy Street Providence, R.I. 02903 E-mailaddresPsmcgill @ lifespan.org 15. APPLICANT CERTIFICATION AND ACCEPTANCE: I certify that the statements herein are true, complete, and accurate to the best of my knowledge, and I agree to comply with the terms and conditions of award if an award is issued as a result of this application. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. I certify that I have read the Ruth L. Kirschstein National Research Service Award Assurance, that I will abide by the Assurance if an award is made, and that the award will not support residency training. SIGNATURE (Required o,,f_ach aptcant) DATE 1C, PHS"ZlI"6-1 (Rev. 06/0"2) r Face Page (Form Page 1) PARIT(Form Pages 1 to 6, 9) Kirschstein-NRSA Individual (To be completed by applicant- 16. APPLICANT S EDUCATION DEGREE MONTH(mm) YEAR (yyyy) B.S. 6 2001 Ph.D. 5 2006 17. APPLICANT S TRAINING/EMPLOYMENT ACTIVITY/ BEGINNING OCCUPATION DATE (mm/yy) N/A Fellowship Application follow